Cytokines Predict Increased Mortality in Dialysis Patients

BARCELONA—Pro-inflammatory cytokines are a marker for increased cardiovascular and overall mortality in dialysis patients, new research demonstrates.

As part of the RISCAVID study, principle investigator Vincenzo Panichi, MD, of the department of internal medicine at the University of Pisa, Italy, and colleagues determined levels of C-reactive protein (CRP), interleukin-6 (IL-6), and interleukin-8 (IL-8) at study entry in 757 hemodialysis and peritoneal dialysis patients treated in Central Italy and followed up for 30 months.

At baseline, almost half of the cohort had high baseline CRP levels (over 5 mg/L), one quarter had CVD, and 19% had diabetes. Junior investigator Sara Beati, of the RISCAVID study group, presented study findings here at the 44th Congress of the European Renal Association-European Dialysis and Transplant Association.

During follow-up, 244 deaths occurred—111 related to CVD and 133 not CVD-related—for a CVD mortality rate and overall mortality rate of 5.9% and 12.9%, respectively, the investigators found. In addition, 67 major CVD non-fatal events occurred.

CRP was the strongest independent predictor of all-cause and CVD events, Beati reported. For example, cardiovascular mortality rates were 14.4% among patients with a baseline CRP in excess of 5 mg/L compared with 7.9% for the over-all cohort; overall mortality was 34% among those with the same high baseline CPR levels compared with patients in the lowest tertile of CRP level (less than 3.5 mg/L), those in the highest tertile (above 10 mg/L) had a two times higher CVD mortality rate and a 2.5 times higher overall mortality, researchers reported.

Furthermore, 21% of patients with high baseline levels of all three pro-inflammatory cytokines suffered a CVD-related death compared with 5.7% of those with the lowest baselines levels, the study showed. With respect to overall mortality, the proportions were 44% and 17%, respectively.

Dr. Panichi suggested that ultrapure dialysis or high-flux hemodialysis may help control pro-inflammatory cytokine levels in this patient population.